/ 



RG 156 
.L83 
Copy 1 



AN 



E S S .A. Y 



EEMOTE AND PKOXIMATE CAUSES 



MIASMATIC FEVER. 



BY 



O. A. LOGAN, M. D. 



PUBLISHED BY ORDER OF THE LEAVENWORTH MEDICAL AND SURGICAL ASSOCIATION. 



LEAVENWORTH : 
PRINTED AT THE DAILY CONSERVATIVE BOOK AND JOB OFFICE. 



1861. 



4 




AN 



E S S A. Y 



ON THE 



EEMOTE AKD PEOXIMATE CAUSES 



OF 



MIASMATIC • FEVER. 



BY 

O. A. LOGAN, M. D. 



^1 



PUBLISHED BY ORDER OF THE LEAVENWORTH MEDICAL AND SURGICAL ASSOCIATION. 



7 

LEAVENWORTH : 
PRINTED AT THE DAILY CONSERVATIVE BOOK AND JOB OFFICE. 

1861. 




V 3 



* 



ESSAY ON THE REMOTE AND PROXIMATE CAUSES OP 
MIASMATIC FEVER. 



READ BEFORE THE LEAVENWORTH MEDICAL AND SURGICAL 
ASSOCIATION, BY C. A. LOGAN, M. D., FEBRUARY 1, 1861. 



Mr. President and Gentlemen of the Association : 

At the meeting of your Association, held upon the first Thursday in January, of 
the present year, a very able essay upon the subject of "Malarious Fevers," was read 
before your body. 

In the discussion which followed, the writer of this paper took occasion to express 
his dissent from the commonly received doctrines upon the subject, and also to put 
forward, in a crude manner, some ideas which were original with himself. 

The object of this essay will be to elaborate those ideas to a certain extent, and 
likewise to advauce the author's reasons, for his presumptuous heresy in the Malarious 
dogma. 

In doing this, perhaps, an apology is necessary for again bringing the subject under 
discussion ; but as a correct knowledge of periodic fevers, their causation and treat- 
ment, is of paramount importance to the "Western practitioner, it is probable, that 
much good may result to all, by a free interchange of experience and sentiment. 

The exciting cause of that peculiar class of fevers distinguished by periodicity, is 
asserted to be, a subtle agent which has received the designation of Malaria, 
Miasmata or Marsh Miasm ; the first two terms as generally used, being indicative of 
its nature, and the last, of its origin. 

Of all the mysterious agents, which lurk in every hidden shape to prey upon the 
health and happiness of the human family, this demon is invested with the most ex- 
travagant, contradictory and incomprehensible properties. 

Although the idea of pestiferous emanations from low, swampy localities, is coeval 
with the fall of man, perhaps, yet a Roman physician, Lancisi, in 1695 obtained the 
questionable credit of seizing this monster from out the varied collection in Pandora's 
Box, and exhibiting his distinctive species to a wondering world. 

Since that period, new attributes have been added, to meet the objections that have 
been urged against the reality of the etherial and insidious foe, until at this time, 
the theory of his composition and properties is so arranged as to meet, however im- 
perfectly, every attack that may be brought against him. 



4 



4s examples at a glance, of the harmony of the theoretical properties of this 
specific poison, may be mentioned the following, collated from standard authors. 

Miasmata are produced by vegetable decomposition, and " are dissipated, arrested, 
decomposed, absorbed or respired by plants." Miasmata are produced by a certain 
degree of beat, and are checked, by a certain other degree of heat . Miasmata are 
generated profusely at a temperature between 60° and 100°, and yet are dissipated by 
the ordinary heat of a camp or house fire . 

Miasmata being generated profusely by vegetable decomposition, it is found nec- 
essary to account for the absence of the effects of the poison in large cities, and old 
settled communities, by supposing an antidotal property in the smoke of cities, and 
the highly cultivated condition of old settled communities. Miasmata are of greater 
specific gravity than the atmosphere, yet are blown by winds over the highest elevations. 
Miasmata are produced by moisture, and a degree of heat between 60° and 100° F, 
( being checked at a temperature either below the first or above the second, ) £nd yet, 
says a celebrated author, " the noxious effects of Malaria are for the most part pro- 
duced in all their virulence and intensity in autumn, after the heat and drought of the 
summer. The hotter and drier the preceding summer, the more frequent and fatal 
are the autumnal fevers." It having been established beyond di?pute by Ferguson, 
Sir Gilbert Blane and others, that periodical fevers exist where there can be no pos- 
sibility of vegetation, Dr. Pickford sa}~s, " whether Dr. Ferguson has or has not suc- 
ceeded in establishing his views, we need not stop to inquire ; he, as well as Sir 
Gilbert Blane, has at least though unwittingly demonstrated that the absence of 
vegetation may be received as a tolerably sure indication of the presence of malaria. 
Whilst on the other hand, it has been clearly shown that the absence of malaria 
may be fully inferred from the presence of vegetation." 

It is but just to say, however, that Dr. Pickford has gone a step further than 
the generally received theory of malarious production, and entertains quite a com- 
prehensive view of its origin. His ideas will be mentioned presently. 

Miasmata, then, are generally considered to be emanations from vegetable matter 
undergoing putrefaction, through the influence of moisture and a degree of beat 
ranging from 60° to 100° F. And yet it has been recorded by many authorities, 
that per odic fevers in their various types, are endemic to localities where the idea of 
vegetab'e putrefaction, and in some cases, of even vegetable existence, is entirely pre- 
cluded. Dr. William Ferguson has contributed quite a number of such instances in 
his paper on the " Nature and History of the Marsh Poison," copious extracts from 
which, may be found in Watson's Practice of Physic. 

Dr. Robert Jackson in his Treatise on Fevers, gives mmy examples of elevated 
localities in the West India Islands, not exposed to currents from swampy regions, 
where periodic fevers prevail. 

Dr. Chisholm and others, record the existence of such fevers in argillaceous soils, 
where the reputed travelling facilities of the miasmata could not be adduced in 
explanation. 

Vegetable putrefaction maj exist in its most satisfactory st ite, and y:t this periodic 
iufluence in fevers, be almost or quite absent. 

Is there no vegetable matter in our Eastern States subjected to moisture, and a 
range of temperature between 60° and 100° F. ? Are there no mill-ponds or river- 
bottoms in localities where ague is a stranger, and in which vegetable matter is con 



5 



stantl} exposed to a reeking sun ? On the other hand, why should persons be attacked 
with a periodic disease, upon visiting a " malarious region " for the first time, during 
a period when the thermometer stands below 60°, and all vegetable decomposition is 
suppressed? Yet that such is the case, is within the experience of us all. Here the 
inevitable stock on hand cannot be brought into requisition. Can there be any 
elimination of this morbific principle in our locality at this time, when the earth is 
covered with snow to the depth of several inches? And yet, are not all our diseases 
of a distinct periodic type ? 

We regard the alleged property of miasmata, to lie dormant in the system for an 
indefinite length of time, before being called into action, as having been trumped up 
purely for the purpose of supporting the theory, and as being devoid of all foundation. 
It is entirely averse to what we do know of the manifestations of the disease. Ex- 
perience teaches us that it is when tbe body is debilitated by the summer heat, and 
acted upon by the depressing cold of the autumn night, that the enemy is most likely to 
invade the citadel ; and not when the system is invigorated by a bracing air highly 
charged with oxygen, and the standard of health is at its acme. 

Did it possess any such property, the person having passed through the fall un- 
scathed, would escape until the vernal sun had again done the work of disarranging 
the secretions, and reducing the vital resistance. 

But let us look at this matter of vegetable decomposition a little more critically. 

It is a fact of general observation that malarious diseases are greatly ameliorated, 
if not dissipated, after the occurrence of the first frost ; and yet, it is at this time that 
vegetable putrefaction is most active ; large quantities of vegetation being killed by 
the frost, and subjected to putrefaction by the heat of the ensuing day, which, until 
the cold blasts of winter are upon us, is constantly above 60°. From the same cir- 
cumstances we should expect our vernal periodics to be vastly more violent than 
those of autumn, because immense quantities of dead vegetation from the preceding- 
year, are exposed to a spring sun. Yet all are agreed as to the fact of the mildness 
of the spring attack, compared with the autumnal. 

Vegetable putrefaction is seen under its most favorable conditions, in the m irkets 
and vegetable gardens of large cities, where refuse vegetables are left for hours or 
days sweltering in the hot sun ; and yet, so remarkably exempt are cities from periodic 
diseases, that a peculiar, antidotal property to the operation of miasmata in large 
communities, has had to be invoked to explain away this fatal objection. 

In addition to this, as before remarked, periodic diseases prevail in all their intensity, 
in localities where vegetation is out of the question ; and upon the other hand, they 
prevail but mildly, if at all, in some places where vegetable decomposition is most rife # 

In confirmation of the first assertion, may be mentioned Cleghorn's observations 
upon the diseases of the rocky Isle of Minorca, in the Mediterranean ; Ferguson's 
account of the encampment of the troops in Holland and Spain ; Sir Gilbert Blanc's 
description of the soil of Walcheren, and Ferguson's after-experience there ; and Dr. 
Good, who said " he had seen regular tertians in the highest part of Islington, and 
also on the dry and gravelly coast of Gosport," a situation so healthy as to preclude 
all possibility of malaria. It was particularly remarked in all these places, that they 
could not have been subject to the bloiving over process. . 

To these might be added many other authors in corroboration of the same facts. 



6 



In support of the second assertion, may be related Dr. Pritchett's observations 
while off the Western Coast of Africa and up the Niger. He instances the case of 
Singapore " lying under the direct rays of a vertical sun, abounding in swamps and 
jungle, and where all the conditions for the production of miasm or malaria, exist in 
perfection ; but, yet this p'ace enjoys great immunity from fever." 

Dr. P. further instances the case of the river Hoogly, in Bengal, which overflowing 
its banks during August and September, is accompanied with a great degree of sick- 
ness ; while in May and June when the river is low, and the banks exposed to the 
excessive heats of the sun, there is much less fever. Dr. P., as the result of his expe- 
rience, pronounces the miasmatic doctrine, a mere hypothesis. 

Another thing may be stated in this connection, mentioned by Dr. John Bell. It 
is asserted by the miasmatists, that the evolution of this morbific principle, is checked 
by a beat under 60°, or over 100° F. This being so, the inhabitants of tropical cli- 
mates, as the West Indies, <fcc, should suffer severely during the winter months, with 
periodical fevers, and be exempt from them during the summer months. For, accord- 
ing to Bancroft, in the winter months the average temperature is 70°, a heat favorable 
to the miasmatic exhalation ; while during the summer, the thermometer ranges from 
120° to 140° F. thereby checking its evolution. Yet we know that the winter season 
is that, which is comparatively healthy, and the summer that in which these fevers 
rage with all their violence. 

But it is useless to pursue this matter further. Those of you, who have not already 
done so, will profit by reading Dr. John Bell's views on this subject, who announced 
his disbelief in this agency some thirty-five years ago, and in whose arguments and 
collection of facts, you will find much that cannot be reconciled with the miasmatic 
hypothesis. 

The most delicate analysis of the air, in miasmatic localities, has failed to detect 
any agent which would of itself, produce Malarious fevers ; and yet, when vegetables 
putrefy, the products unite in certain fixed compounds, and as such could not elude 
the chemist's scrutiny. 

So convincing are the proofs against the vegetable origin of periodic fevers, that 
Dr. Watson abandons the theory, and maintains that the specific poison is 
eliminated from a light, porous soil saturated with moisture, and acted on by the 
appropriate solar heat. But to our mind, he has not improved the matter ; for 
examples without number could be given of just such a soil, under precisely the con- 
ditions which he enumerates, that are entirely exempt from such diseases. 

Dr. Pickford of London has recently published a very valuable work ©n Hygiene, 
in which he devotes considerable space to Infection and Contagion, classifying malaria 
under the former head. The author starts off with the remark that the meaning of 
the term malaria, is, a vitiated or contaminated atmosphere ; and from the first page 
or two, we are led to infer that he is about to use the word as expressive of those 
morbific compounds resulting from animal and vegetable disorganization ; noxious 
gases and the like, which when applied to the human body, cause disease by their 
pestiferous properties. Thus far, we have no special quarrel to make with the author ; 
for the analogy of Contagion, whether in its solid, liquid or aeriform condition, strikes 
us as being at least reasonable, knowing as we do, by actual observation, that the con- 
tagion of typhus will invariably produce typhus ; that of syphilis will produce syphilis: 
that of small-pox will produce small-pox, &c. 



But here the contagious principle is specific, always produced from the same cause, 
and we are accordingly surprised to find the author while asserting that " marsh miasm 
is a specific poison, inducing specific effects upon the human body," defining marsh 
miasm-, (used synonomously with malaria) to consist " of invisible and pestiferous 
emanations from the surface of the earth, and of poisonous and gaseous exhalations 
and effluvia from animal and vegetable matter in a state of decomposition ; or accord- 
ing to Schonbein, of gaseous matters the product of purely chemical, or physical or 
physiologically chemical actions taking place within the earth or upon its surface ; in 
stagnant waters, or in the atmosphere itself." 

It would be rather wonderful, if in this comprehensive definition, the specific poison, 
allowing there is one, should not be included. To this definition it may be urged, 
that the conditions for the generation of this poison, may all be present in perfection, 
and yet not result in the production of the specific disease, periodic fever. 

Did any one ever know of the contagion of gonorrhoea producing syphilis, or that 
of small- pox producing scarlatina ? Yet these would be no more impossible than 
that, where a specific poison is eliminated by the existence of its prescribed conditions, 
there should be au absence of the specific disease ; or where there is an absence of the 
specific poison, the disease should rage in its intensity. 

Would a physician be apt to credit the assertion of a patient, that he had con- 
tracted a primary chancre spontaneously ? 

In order to establish a specific cause for anything, it must be shown to follow in- 
variably, certain conditions, and as invariably to cause certain effects. 

As Dr. Pickford advances in his account of malaria, he becomes so obscure 
and contradictory, as to be quite incomprehensible. At one time he urges the mala- 
rious poison, as the specific cause of periodic fever, and then speaks of it, as causing 
cholera. 

Again he speaks of malaria in a general way, implying a depraved condition of the 
atmosphere, and then attaches to it, its specific influence. Again he speaks of miasmata 
as the result of vegetable decomposition, and represents their effects as being destroyed 
by a profuseness of vegetation. Again, where it has been shown that no vegetation 
could exist to putrefy, then, the poison, " like Banquo's ghost, that would.not down," 
is set free from the aqueous material of the earth or air, and rages like a pestilence, 
because there is no vegetation to absorb it. 

" It only remains to be shown," says he, " that malaria abounds in its most deadly 
form where little or no vegetation exists to deprive it of its poisonous properties, and 
that where vegetation does exist in abundance, with free ventilation, malaria is ren- 
dered almost, if not entirely innocuous." Here follow the instances which Ferguson 
and others, adduce to prove that vegetation has no part nor lot in the production of 
periodic fever. 

However valuable the other portions of the work are, Dr. Pickford has certainly 
not cleared up the irreconcilable nature of this agent. 

Nor can it be said, that the effort upon the part of others to prove the morbific in- 
fluence to be due to gaseous compounds, which infest low and swampy places, has been 
any more successful, in the direction which seeks to attach to them a specific agency. 
That they may become indirectly instrumental in the production of fever will be 
shown hereafter. 

These gases, it may at present be remarked, are the carbonic acid, carburetted and 



8 



sulphuretted hydrogen. Of these, Prof. Daniell has supposed the latter, to be the of- 
fending poison : but to this it need only be answered in the language of Dr. Bell, that, 
" if such were the case, the inhabitants of large cities, where this gas is generated pro- 
fusely, would be the greatest sufferers." 

But Prof. Gardner, (Medical Chemistry) believes that he has detected the poison, 
" in a certain instable organic body, of which sulphur is a component, and which may 
be obtained by precipitating the vapor from a marsh in the morning before sunrise, 
and it blackens sulphuric acid. It consists of sulphur, carbon, hydrogen and probably 
oxygen. ****** This substance entering the lungs, is probably decom- 
posed into sulphuretted hydrogen, carbonic acid and water. Hence the sulphuretted 
hydrogen is most probably the noxious body ; this enters the circulation, affects the 
blood, produces nervous symptoms, which have the intermittent or remittent type ; af- 
fects the liver and if taken in large quantity, produces nervous and vascular prostration 
with all the symptoms of yellow fever. These would be the effects of sulphurretted 
hydrogen. The best remedies, calomel and in chronic cases nitro-muriatic acid, both 
contain chlorine. The first of these is decomposed in the body, and they both evolve 
chlorine, which as we have seen, neutralizes the poisonous properties of sulphuretted 
hydrogen." 

We are not able to discover the active difference between this theory aud that of 
Prof. Daniell, as the poison is the same in both ; and whether it is inhaled as sulphur- 
etted hydrogen, or generated in the lungs as such, can matter but little. Both theories 
are open to the same objection. In localities where sulphurretted hydrogen is evolved 
plentifully, ( in large cities, &c, ) its effects are not manifested in the production of 
periodic fevers. 

And there maybe particularly urged against the hypothesis of Prof. Gardner, those 
cases before narrated, where these fevers occur in localities entirely destitute of ma- 
terials to evolve an organic body, in the sense in which he employs the term, [vide 
Cleghorn, Ferguson, Good etc.) ; and also others, (as the swamps and jungles of Africa 
mentioned by Pritchett) where such a principle would be formed in its greatest per- 
fection, and where the inhabitants are remarkably exempt from the disease. 

With such facts staring us in the face, why do we so tenaciously adhere to a mythical 
assumption, incapable of demonstration by facts, and seldom made plausible by the 
remotest analogy ? 

In the absence of any positive data, to establish a probability of specific influence, 
such as contagions, epidemics &c, much more reasonable, because according with ob- 
servation and experience, is the theory advanced in recent years, which attributes 
periodical fevers to the poisonous influence upon the nervous system, of an undue 
accumulation of carbonaceous material in the blood, from whatever cause produced. 

During the last seven years, it has been our fortune to reside in what are termed, 
malarious districts ; and we trust that we have honestly and laboriously studied these 
diseases, with a view to arrive at the truth. We may not have interpreted the book 
of nature intelligently, but the records of those seven years, have induced us to re- 
nounce the malarious doctrine, as not only fallacious, but as pernicious, because leading 
to a disregard of necessary measures of hygiene, and to a perverted medication. 

To exemplify fully our position, we shall be necessitated to go into a detail, which 
may be considered tedious, but which the importance of the subject fully demands, if 



9 



we are to consider ourselves honest seekers after truth, regardless of theories whose 
etherial foundation is as light 

"As the baseless fabric of a dream." 

In instituting an investigation of this kind, it becomes us to possess ourselves of an 
accurate knowledge of the organism in health, and then to note elaborately, those parts 
of the machine, whose function departs from the standard of integrity, necessary to the 
maintenance of a healthy equilibrium in the whole. 

Probably, no point connected with this whole discussion, is settled upon with more 
unanimity than that the liver and spleen play an important part, in the progress of 
periodic fevers. Thus far, the road is a common one ; but when the question arises, as 
to whether it be of a primary or secondary nature ; the cause or the effect of a cause, 
it divides and leads to conclusions as opposite as the poles. 

The liver has been termed, with reference to its depurating function, the abdominal 
lungs. It is a part of the physiological function of the liver, to remove from the 
circulation, in a very peculiar manner, large quantities of effete hydro-carbonaceous 
material, the result of the disintegration of the tissues, or the product of nutritive 
absorption. It accomplishes this act in the first case, by converting the excremen- 
titious particles into glyco-cholic and tauro-cholic acids, the active constituents of the 
bile. These principles are made to play an important part in intestinal digestion, by 
being poured into the duodenum, in conjunction with the pancreatic flu'd, where, after 
exercising an influence upon certain portions of the chyme, they are re-absorbed and 
carried again into the general circulation. Here the hydro-carbonaceous constituents 
of the acids above mentioned, are oxydized and eliminated by the lungs in the form of 
carbonic acid and water ; while the other principles, as the alkaline bases and sulphur 
of the taurine are excreted by the kidneys. 

In the second case, or where the hydro-carbonaceous material is the product of nu- 
tritive absorption, the liver converts all saccharine matter that may be brought to it, 
into liver sugar, and all oleaginous matter into liver fat, metamorphoses highly favor- 
able to oxidation. These being carried into the circulation are burnt up, and yield 
carbonic acid and water. 

Thus is a large quantity of carbonaceous material indirectly got rid of, being first 
made to subserve a purpose in digestion, and afterwards in the most eligible form, 
carried into the circulation, and aiding by its combustion in the sustenance of animal 
heat. 

Upon glancing at this portion of the function of the liver, we remark that it does 
not eliminate the carbonaceous matter, in extra-uterine life, directly ; but prepares it 
in an eligible form for oxidation or combustion, and is thus subordinate to the respira- 
tory process. This preparation is absolutely essential to life, as a transforming 
agency is exercised over the constituents of which the bile is composed, without which 
death would be. consequent upon their retention in the system. 

The importance of this fact will be shown more fully hereafter. 

We have in the skin, an efficient and important adjuvant to the lungs. Although 
the skin has been usually considered, to be allied in function with the kidneys exclu- 
sively, and in disease or obstruction vicarious to them, yet, numberless experiments 
have demonstrated the large amount of carbonic acid thrown off from the cutaneous 
surface in vaporous suspension. The most remarkable of these, are those of Dr. 
2 



10 



Fourcalt, Anselmino, Lavoisier and Seguin, Valentin, Bischoff, Majendie, Regnault 

and Rjis3t, and probably others. 

Foarcalt applied an impermeable coat of varnish over the skins of animals, which 
gave rise to a state termed by him "cutaneous asphyxia," marked by imperfect arttri- 
alization of the blood and subsequent death. 

Seguin by inclosing his body in an air-tight bag, found by experiments carefully 
repsated, that the maximum loss in a state of rest, by pulmonary and cutaneous ex 
halation is 18 grains in a minute ; and of these, eleven pass off by the skin, and seven 
by the lungs. 

Of this exhalation, Regnault and Reiset have endeavored to ascertain what propor- 
tion is constituted of carbonic acid, and have arrived at the conclusion that l-50th as 
much is thrown off from the skin as from the lungs. 

But as Majendie and Fourcalt observed that when animals are covered with an im- 
permeable coat of varnish, they soon die asphyxiated, the heart and lungs becoming 
gorged with blood, it is highly probable that a much greater amount is thrown off 
from the skin; as effects of such severity could not ensue from the mere retention of 
water in the system, which could easily be discharged by the kidneys or lungs. 

Analagous effects to these ensue upon individuals subjected to great heats. Persona 
have gone with impunity into ovens whose temperature was from 400° to 600° F, when 
the air was perfectly dry, so as not to interfere with the rapid exhalation from the 
skin ; but when the air was moist, preventing evaporation, the heat which could be 
borne with safety, was quite insignificant. 

These observations prove conclusively, the auxiliary nature of the cutaneous func- 
tion, to the lungs, in ridding the system of carbonic acid. 

This being the case, what effects are we to expect, and what results do we observe to 
follow, a suppression from external influences of this important function ? 

We answer to the latter question, that all the phenomena of periodic fever, have oc- 
curred in nou-malarious regions consequent upon climatic vicissitudes, whereby the office 
of the skin has been interfered with or checked. Let us look at the immediate conse- 
quences of an interruption to the cutaneous respiration. 

The large amount of disintegrated material, which it is the province of the skin to 
eliminate, is thrown upon the system to be expelled through other channels, or failing 
in this, to produce their respective toxaemic effects. In the case of the nitrogenized 
excretions, the kidneys come to the rescue and perform the duty of removal, if not too 
long burdened with it. The same is true of the lungs, to a certain extent, with the 
hydro-carbonaceous matter. But if the obstruction have existed any considerable 
length of time, and particularly if the period be one of great solar heat accompanied 
with a humid atmosphere, they are not equal to the double office. The consequence is, 
an imperfectly arterialized condition of the blood from a superabundance of hydro- 
carbon in the circulatory mass. 

The liver now, through its decarbonizing function, is stimulated to increased activity 
by the super-amount of hydro-carbonaceous material presented to it, to metamorphose 
into fat and sugar, and to work up intc bile. The increased supp'y of bilious matter 
will then, p3rhaps, be poured into the duodenum, and stimulating the intestines to ac- 
tion, a " bilious diirrhoei" eniues, an J if the cause have ceased to operate, the individ- 
ual is presently well again. We are acquainted with several persons who are endowed 



11 



with a « safety valve " arrangement of this kind, which protects them in slight attacks 
of " biliousness ". 

But suppose the cause continue to operate, what happens? 

The hydro-carbon converted by the liver into bile, is stored up in the gall-bladder, 
distending it, to its upmost capacity. The starch and other matters transformed into 
sugar, are in that shape sent the rounds of the circulation unoxidized, and brought 
back again to the liver, together with fresh quantities of hydro-carbon. The liver 
soon in consequence of the over-stimulation, falls into a corresponding degree of tor- 
por. The carbonaceous matters accumulate, and congestion of the liver follows, — por- 
tal venous congestion, just as the lungs are congested in the asphyxia produced in 
animals, as a consequence of suppressing completely the cutaneous function. 

At this point the dangerous consequences of the retention of the bile materials in 
the blood, begin to manifest themselves, and disease commences in earnest. Up to 
this time, the invidual has been merely afflicted with the premonitory symptoms 
described in what is called, the forming stage of fever. These symptoms are those 
resulting from impure blood being sent to the great nervous centres, such as a general 
aching and languor ; dullness ; an indisposition to mental or other exertion ; headache ; 
pain in the side, perhaps : sleepiness ; in short, that state of good-for-nothingness which 
the French call malaise. If now the hand of science interpose, and an active cholago- 
gue cathartic b3 administered, together with msasures to restore the secretions general- 
ly, the threatened disease is averted, and the person restored to health. 

Every day do we rescue persons, thus on the brink of periodic fever. We speak 
confidently upon this point, because we have been extremely careful, to look for a 
manifestation of periodic influence at this stage, and have become thoroughly satisfied 
that none are developed, and that the portal congestion with its pathognomonic 
symptoms precedes all periodic indications ; in other words, being the cause, and not 
the effect. This we give you, as the result of seven years' critical observation. 

But, if the cause instead of even now being removed, is intensified, then we have 
the slight pain in either side, ( in the right from the liver, and in the left from the 
spleen, in consequence of the congestion of the portal vein extending to the splenic,) 
or in the shoulder in consequence of the nervous reflection, becoming perhaps, very 
acute ; the symptoms generally are magnified, and others being added, they culminate 
in a " chill," and the periodic influence is established. 

It must be remarked, that these symptoms do not flow from the absorption of bile 
into the system, for this result may ensue and be attended with no serious evil for some 
time ; but it is the retention within the system oj the elements out of which the 
bile is formed, which poisons the nervous centres, and if not obviated, eventuates in 
death. 

We cannot do better than quote Dr. Carpenter's words in this connection : — "When 
from any cause the secretion of Bile is suspended, the substances at the expense of 
which it is formed accumulate in the blood ; and their excrementitious character is 
strikingly demonstrated by the disturbance of other functions, especially those of the 
nervous system, which ensues. When the suppression is complete, the patient suddenly 
becomes jaundiced, the powers of that system are speedily lowered/ (almost as by a 
narcotic poison) and death rapidly supervenes. Where the secretion is diminished, 
but not suspended, the same symptoms present themselves in a less aggravated form. 



12 



It is probable that much of the disorder in the functions of the brain, which so 
constantly accompanies deranged action of the digestive system is due to the less severe 
operation of the same cause ; namsly, the partial retention within the blood of certain 
constituents of the bile, which should have been eliminated from the circulating fluid. 

****** reabsorption of bile into the blood, as seen in ordinary 

cases of jaundice dependent upon the obstruction of the biliary ducts, does not act on 
the general system in a manner nearly so injurious as the retention of the matters at 
the expense of which it is formed, has been shown to do. ****** ^ nc l 
when it is remembered that the greater part of the bile which passes into the intestinal 
canal is ordinarily destined for reabsorption, it seems fair to conclude that the matters 
which accumulate in the blood when the secreting action of the liver is suspended, are 
not in the same condition with those which are received back into it after being sub- 
mitted to that action, and that the liver therefore, not merely separates them, but ex- 
ercises a certain transforming agency upon them, as it is known to effect upon other 
constituents of the blood which pass through it." 

Dr. Budd, upon a careful consideration of these facts, has arrived at the conclusion, 
that it is not the action of the retained materials themselves upon the system, which is 
so injurious ; but that while circulating in the general current, some metamorphosis 
occurs, by which a more noxious poison is generated. This however, is a mere specu- 
lation, supported only by the analogy of Uraemia. 

However this may be, such are the consequences of the suppression of the cutaneous 
function for any considerable length of time. Such accumulation of hydro-carbon may 
occur and frequently does, as a direct consequence of climatic conditions. Currents 
of thermo-electricity caused by the earth's motion from west to east, create unequal 
temperatures, these differences induce in the atmosphere either an increased or dimin- 
ished capacity for retaining water in suspension. 

But independently of the condition of a hot and humid air, the oxygenating process 
may be directly interfered with, by a deficiency of oxygen in the atmosphere. This 
may ensue as the consequence of certain electrical conditions, or from the poisoning of 
the atmosphere by gaseous exhalations, either from swamps, or other pestiferous causes. 

The allotropic body called ozone, being the great disinfectant of nature, is generated 
under certain climatic conditions, much more profusely than under others. These con- 
ditions, so far as we know, are not definitely settled ; but our own experience is, that a 
hot and dry season following a wet spring, is not only unsuited to its free evolution, 
but to its existence in the air. Probably the causes, are due to the fact of the copious 
chemical changes taking place from the surface of the earth, in consequence of the 
spring inundation and the subsequent heat. In this way, noxious compounds are gen- 
erated, which require the ozoniferous agent to neutralize, and which rob the air of its 
presence. During seasons of plentiful thunder storms, however, with their sharp elect- 
rical manifestations, the allotropic oxygen exists in abundance, as may be easily de- 
termined by the ozone paper. These are the seasons, which are marked in malarious 
districts by good health. A copious rain-storm with its accompanying electrical dis- 
charges, occurring during a sickly season, will often arrest the sickness for several days. 

Though our observations have not been made with the accuracy which we intend to 
use hereafter, yet the experiments of the last three years, have gone far to convince us , 
that there is a direct relationship between the amount of prevailing sickness, and the 
actual quantity of free ozone in the air. 



13 



During cold winter seasons, when the disenfectant properties of ozone are not re- 
quired, it exists largely in the air, and oxidation is excessive ; the diseases assuming 
the inflammatory type. This will be mentioned again. 

There is reason to believe that ozone is also generated in the higher regions of the 
air, and is brought down with the rain-drops ; hence the purifying influence of rain is 
partly due to this agent. 

Here permit us to remark, though not relevant to the subject, that we have been un- 
der ths conviction for soma time, that as th.3 peering eyj of science, shall unravel the 
mysterious laws of nature, that this body will be found to bs closely allied to electri- 
city itself; of one thing we are convinced ; that cxygen is the active constituent of 
the electric fluid, but whether in an allotropic state, or one of powerful combination, 
time alone will reveal. We have observed many singular things in our experiments 
with ozone, which we may present at some future time for your consideration. 

Thus much for deficiency of oxygenating material in the air. But it must not be 
imagined, that these causes only, are competent to produce an accumulation of the 
hydro-carbon element in the blood. The liquid and solid ingesta of every person, en- 
ter largely into the process. 

An individual who, during the hot season, partakes freely of the calorifacient food, 
whereby ample quantities of carbon are generated in the system, and that too, at a 
period when the respiratory process is much less active, because of a diminished quan- 
tity of oxygen in the air, and particularly if it be humid, impeding exhalation not only 
from the lungs, but likewise from the skin, is apt to suffer the same consequences. 

Nature has taught the rude Esquimaux in the frozen regions of the North, that to 
maintain his animal heat, he must live almost exclusively upon a carbonaceous diet. 
Accordingly we find him revelling with the delight of an epicure, upon such nauseous 
articles as "blubber," and "train oil." The same kind mother has taught the dark 
skinned Nubian, who basks beneath an equatorial sun, to ignore such food, and has 
furnished him with a plentitude of fruits and vegetables, which, while they produce the 
requisite histogenetic materials, yield large quantities of water; this being exhaled 
from the skin, by its evaporation, keeps down the actual temperature of his blood, to 
that of his ice-bound brother in the frigid zone. 

Between these extremes, we have two classes of disease, according to the tempera- 
ture and atmospherical condition of the locality. In high latitudes, marked by long 
and cold winters, and condensed dry air, oxygen exists in abundance, and the tendency 
is to inflammatory affections, brought about by excessive oxidation. But when we 
merge into a higher temperature, where the air is rarefied, humid and deficient in oxy- 
gen, then are brought into view an entirely different set of diseases, marked by imper- 
fect oxygenation, and a consequent accumulation of hydro-carbon in the system. These 
are no theoretical speculations, but well attested facts. 

Let us see then, how observation would teach us to regard periodic fevers, as diseases 
dependent upon imperfect oxygenation. First then, the localities in which they occur 
is strong presumptive evidence, that such is the case. What is the fact connected with 
their attacks ? It is notorious that those persons who are exposed to atmospherical 
alternations ; the hot, beaming sun of mid-day, and the cold dews of night impregnated 
with the nocturnal, vegetable exhalation of carbonic acid ; who are badly clothed ; 
badly fed ; eating sparsely of fruits and vegetables, and largely of a carbonaceous diet, 
as fresh and salt pork, which has lost its soluble salts by "pickling' ' ; those living in 



14 



illy-ventilated habitations, particularly if they be near some pond or stagnant puddle, 
where carburetted hydrogen, carbonic acid and other gases not only poison the atmos- 
phere, but by their strong attachment for oxygen, rob it of that element, to say noth- 
ing of the vaporous cloud by day, and the dense fog by night, interfering with the 
cutaneous exhalation ; those whose systems are not only enervated by the stimulus of 
solar heat, but also by bad whiskey ; these are they who suffer mostly from attacks of 
the disease, while the better class, who are enabled to adapt their regimen to the require- 
ments of the system ; to protect themselves against climatic conditions, avoiding the 
heat of the day, and the dews of the night, are they who enjoy almost entire immunity. 

The infamous Pontine Marshes are an example of this. The nobility live with im- 
punity upon the borders, during a season rife with disease, by retiring into their houses 
before the cooling of the earth has condensed the watery and gaseous exhalations, and 
not venturing forth in the morning before the genial sun has again dissipated them. 

Folchi upon observation of such facts in Rome and the adjoining Campagna, re- 
nounced the malarious doctrine. Napoleon during his campaigns in Italy took advan- 
tage of this and protected his army from the incursions of the endemic diseases, by 
buildirg camp fires after the going down of the sun. The inhabitant of our Western 
States are acquainted with this fact, but unfortunately, the hardships and discomforts 
of a pioneer life, do not permit them to profit by it. When, after a few years of labor, 
they have accumulated a sufficiency to attend to these hygienic principles, and cultiva- 
tion has drained the locality of its swamps and sloughs, with their attendant fogs, 
strangely enough, periodic fevers almost disappear ; and yet none of the requisites for 
vegetable decomposition and the consequent evolution of miasmata, are done away with. 

What seasons are they, which are marked by the greatest prevalence of these fe- 
vers ? Every experienced Western man will tell you , that it is after a spring marked 
by copious and prolonged rains, followed by a hot summer, that the ravages are great- 
est. In other words, when the earth, thoroughly saturated with water, is acted upon 
by a summer sun, and the locality enveloped in a cloud of steam by day, and a pall of 
fog by night. These are the times, wmen the reading of the feammfiter constantly 
gives notice of the great density of the atmosphere, that the destroying angel is abroad 
in his might. In the tropical atmosphere of Africa, and other places, where this class 
of disease is so fatal and pernicious, we are informed by writers upon the subject, that 
the dew-point is but 5° below the maximum heat of the day. Does it require the aid 
of malaria to explain the aetiology of these diseases in such a locality ? And yet, we 
will venture the assertion, that much of the same meterological phenomena exist, pro- 
portionate to the intensity of the manifestation of the disease, in all other localities 
which it scourges. But a volume might be written upon atmospherical influences upon 
the human economy in the production of disease. 

Let us look what evidences the symptoms furnish us, that this is a disease of im- 
perfect oxydation : 

Every indication, from the first inception of deranged action, points conclusively to 
the fountain-head of the difficulty. The languor, weariness, indisposition to thought, 
all tell us, that the great nervous centres have been cut off from their wonted supply 
of oxygen ; while the pain or stitch in the side ; the tenderness on pressure ; the yel- 
lowish fur upon the tongue, perhaps; the yellowish or dull-bluish tinge of the con- 
junctivae ; the craving for acid drinks ; and the urine which is scanty and high- 



15 



colored, but which, in all probability, upon being sufficiently diluted with clear water, 
will assume a yellow hue, evincing the presence of the coloring matter of the bile, the 
redness being a mere concentration of color ; or failing in this upon being sweetened 
and adding pure sulphuric acid guttatim, will evince the beautiful play of colors from 
yellow to cherry, carmine and violet ; and also from the diminution or absence of phos- 
phates in the urine, showing that the destruction of nerve-tissue is interfered with, 
because of the impairment of the oxygenating process ; all these unerringly indicate 
that the depurating function of the liver is interfered with, and the elements of the 
bile are being circulated through the channels of life. 

The craving for drinks of an acid character, was mentioned above. This according 
to our observation, is a very frequent symptom of the fever when fully established. 
Almost the first question propounded by the patient to the physician when called to 
treat a case of fever, is whether he may not have some lemonade, or even cider to 
drink. Oxygen is the great acidifer, (although technically doubted by some chem- 
ists,) and this demand is but the still small voice of nature calling for the needful ele- 
ment. But apart from these symptons, although the various analyses of the blood of 
patients laboring under periodic fever, have not been very satisfactory, because, per- 
haps, not conducted with the requisite care and skill ; yet Cozzi's analysis in four cases 
demonstrated, in the majority, a large excess of cholesterin, and scarcely any phos- 
phates, while the bile-pigment was in excess. 

Do we here need a finger board to point the road to the suffering organ ? Prof. Jos. 
Jones of Georgia, in a very elaborate essay read before the American Medical Asso- 
ciation, at its meeting in 1859, says that during the malarial fever, animal starch accu- 
mulates in the liver and that there exists an absence of grape sugar. To our mind, this 
strongly evinces the extent to which the transforming power of the liver is perverted. 

The spleen, we consider also, to furnish evidence of the hepatic origin of periodic 
fever. Among the first symptoms of the derangement of health is a pain over the re- 
gion of the spleen, sometimes of an acute and lancinating character, though generally 
described as a simple soreness. This exists before the phenomena of the chill are man- 
ifested, and cannot be due to distension during the cold stage, because preceding it 
sometimes for days. It evidently arises from a condition of passive hyperemia in the 
organ, and is the result of the portal derangement. In thin subjects, a very careful 
percussion will detect a slight abnormal dullness over the left hypochondrium. If now, 
free bilious stools be produced, the unpleasant visitor speedily vanishes, for the very 
simple reason that the cause is removed. This is a matter of such common observation, 
that it need not be dwelt upon. It must have been the constant relationship between 
disorder of the liver and spleen, that induced M. Piorry, to regard the cause of periodic 
fever, as resident within the latter organ. If the admonishing symptoms already describ- 
ed, are allowed to go on, under the hope that they will "wear off", and a chill should 
occur, then indeed is the innocent spleen subjected to a distension, which if not soon ob- 
viated interferes most sadly with the part which, Kolliker, maintains, it plays in the man- 
ufacture of the red blood globules. You have all seen patients thoroughly blanched, 
even after one chill. Such is the case with a member of your association ; a plethoric r 
florid man when in health, but whom a single chill, is sufficient, to pale as white as snow. 

But, we wish to remark, that it is not always the chill, which, driving the blood from 
the surface, produces the remarkable alteration in volume of the spleen. It is a sub- 
ject of common experience, that the splenic tumefaction is nowise proportioned to the 



16 



severity of the chill ; indeed, we have seen many eases of remarkable splenic engorge- 
ment, in which there had been no chill at all. How account for such cases, except as 
an obstruction to the splenic vein, dependent upon the portal torpor ? Idiopathic 
afi'ections of the spleen are of exceedingly rare occurrence, and its simple congestion in 
periodical levers, is symptomatic of the functional transgressions of the liver. Prof. 
Jos. Jones, in the paper before referred to, thinks that the splenic alterations occur 
anteriorly to the febrile paroxysms. Thus much of the aetiology of this intricate dis- 
ease, do we learn from observation of its functional lesions. But it is a little remark- 
able, that although these admonitions are unheeded by the miasmatists, yet, that in 
their battle with this specific, hydra-headed monster, experience has taught them to use 
those means, which are best calculated to remove the condition above described. In 
the treatment of the disease, from the first feelings of indisposition, up to the fully de- 
veloped remittent, they do not commence upon the anteperiodic ; but precede it by some 
medicine which shall unload the portal congestion; produce copious " bilious stools", 
aud in consequence, a remission if not a complete intermission in the fever ; after which, 
they give the Quinine promptly, to break into the morbid nervous concatenation mark- 
ed by periodicity. Thus, they do not give the " great antidote " until the cause is re- 
moved, or if they do, they signally fail in breaking up the disease, until such an action 
does take place, either naturally or by the intervention of science. We wish now to 
be understood as referring to ordinary attacks, and not to those where the symptoms 
are so violent as to require the immediate mitigation of the periodic manifestation, and 
the sustenance of the nervous system by stimulants under the narcotic depression of 
the poison, for fear of a speedily fatal issue. Even in such cases we but establish a 
truce, until we tnrust the enjmy out. We make these remarks with hesitation, because 
it places us in opposition to others, whose opinions we respect ; but experience in 
every variety of treatment, has convinced us of their truthfulness. 

The agent most frequently used for exciting the hepatic function is mercury, and 
of its preparations, the mild chloride is the most efficient. This remedy while stimu- 
lating the liver freely, is decomposed in the system and liberates chlorine, an agent that 
seems to exert an action upon that organ, second only to the mercury itself. Dr. Wal- 
lace in a paper published in the London Lancet in 1821, contends for a specific 
influence upon the liver, resulting from its use. Dr. E. D. Fenner, of New Orleans, we 
believe, employs it for the same purpose, although we have never seen his views upon 
the subject. Whether it acts by a specific influence upon the liver, or simply by vir- 
tue of its strong attraction for hydrogen setting free a certain portion of oxygen, we 
are not prepared to say, but experience has taught us to regard it as a valuable ad- 
juvant in the treatment of these diseases, whether of their primary or secondary 
manifestations. 

In the former, chlorine combined with mercury, as the mild chloride, is its most 
eligible form. But in cases, where the direct attacks of the disease have been broken 
up, and there is a tendency to hepatic torpor still existing as a sequence, we find 
the Chlorine Water, made according to a formula, we shall be glad to furnish you at 
any time, a most reliable article. Under the same conditions, the nitro-muriatic acid 
may be given, in doses of four or six drops in water or combined with the Tinct. 
Cinchona or Tinct. Gentian, with ranch success. But in that condition of cachexia, 
where the ravages of the disease, have so interfered with the function of the spleen, as 
to prevent its agency in the manufacture of the globular element of the blood, the 



17 



Tincture of the Chloride of Iron, is a remedy of rare efficacy. For while the Chlo- 
rine, (which by the way, is in excess in many preparations) plays its part in the hepatic 
laboratory, the Iron increases the number of the red globules in the blood, and conse- 
quently its capacity f 07- oxygen, by which it is more perfectly decarbonized. 

In administering this agent, however, it is generally necessary to overcome its ten- 
dency to constipation, by combination with some other remedy. But we did not intend 
to touch upon the therapeutics of the subject, save so far as might be necessary to 
illustrate its pathology. 

Against all that has been said, however, and in favor of a specific cause of these 
fevers, is urged the periodicity attending them. This is a disease emphatically of the 
n?rvous system, whether it be caused by miasmata, or an imperfect oxidation of the 
blood. We need not call into requisition a specific agent to account for the period- 
icity. Periodicity is an inherent property of the nervous system, (fully demonstrated 
with reference to that portion called the sympathetic) and stamps its impress upon all 
diseases in .which that system is seriously involved. The action of the heart is period- 
ical. This cannot be due to the stimulus of the blood, for it will continue to beat 
some time after its removal from the body. This is strangely shown by the hearts of 
the inferior tribes. The heart of the Sturgeon when severed from his body, and hung 
upon a nail, will continue its rhythmical action for four hours. In these cases the 
motor power must be derived from the sympathetic ganglia found within its substance. 

The uterus is periodical in its action, not only in reference to the menstrual nisus, 
but in the effort of parturition. The same is true of the rhythmic action of the 
stomach and intestines, and although these instances are valid only to show the period- 
icity manifested in the operations of the sympathetic, yet the agency of the medulla 
oblongata in maintaining the muscles of respiration in uniform rhythmic action, proves 
conclusively the same property of intermittency. The periodical tendency to sleep 
may also be adduced in illustration of this property, a? well, perhaps, the tendency to 
wink at intervals, whereby the retina is afforded a short period of rest. 

Neuralgiae, by their intermittent character are treated most successfully by antiper- 
iodics, as Quinine and Arsenic, and this when they are disconnected with the possibility 
of malaria. 

Strong excitation upon the extremities of centripetal nerves, may induce regularly 
intermittent paroxysms, as the introduction of a bougie, &c. When the medulla ob- 
longata is stimulated through a centripetal nerve, as when cold is applied to the skin, 
the impressions are reflected, so as to produce movements, which, though they may be 
quick and almost convulsive, are yet combined in the plan of the proper respiratory 
acts. (Kirkes and Paget's Phys.) 

We are all familiar, perhaps, with the experiment of M. Brachet, who for seven 
nights in succession, took a cold-bath at mid-night in the river Saone, after which he 
went to bed, and was soon in a profuse perspiration. At the end of seven nights, he 
discontinued the experiment, and much to his surprise, for seven nights more, a true 
ague fit, completing all its stages, occurred at the same hour ; but was at length inter- 
rupted by a ride to a female in labor, just before the commencement of the paroxysm. 
The physiological application of this case is obvious. Cullen had some idea of this 
property of the nervous system, when speaking of a " diurnal revolution." "Whether 
this depends," he remarks, " upon the original conformation of the body, or upon cer- 
3 



18 



tain powers constantly applied to it, and inducing a habit, I do not know ; but the 
returns of sleep and watching, of appetites and excretions, and the changes which reg- 
ularly occur in the state of the pulse, show sufficiently that in the human body, a diur- 
nal revolution takes place." What may cause the differences in type of periodic fevers, 
as the quotidian, tertian, quartan &c, we do not know, unless it be an intensification 
of the cause, marked by the shortest periods. We believe then, that whatever may be 
the agent, which produces the so-called malarious fevers, that the periodicity is no part 
of it ; but is an innate property of the nervous system brought into morbid develop- 
ment, by the pernicious operation of the poison. 

It is urged against the view, which attributes periodic fevers to an accumulation of 
bile elements within the system, that these fevers seldom occur in old-settled communi- 
ties. This to our mind, is one of the most potent objections to the miasmatic doctrine, 
for, however well-drained a country may be of its swamps and marshes, yet the require- 
ments, of vegetation acted upon by heat and moisture cannot be done away with. 

A much more rational conclusion would be to attribute the decline of the disease to 
better hygieni2 conditions brought about by the removal of pools &c, which keep the 
air saturated with moisture and pernicious gases ; by better clothing ; better dwellings 
and better habits in relation to labor, exposure and diet. 

Of the diet may be particularly mentioned, that during the hot season it consists 
mainly of vegetables and fruits ; luxuries almost unknown in the first settlement of a 
country. These contain much less of the carbonaceous constituents, than an animal 
diet, and being composed largely of oxygen and hydrogen, yield large amounts of 
water, which being exhaled from the skin reduces by evaporation, the animal tempera- 
ture, and carries off the carbonic acid in vaporous suspension. 

The inhabitants of tropical climates live chiefly upon rice and fruits, which yield the 
aqueous element very largely. The acid fruits, as the apple, pear, orange, grape 
currant, gooseberry &c, in which the malic acid is the principal acidulous agent, and 
the lime, lemon and tomato, (according to Dr. Plummer, ) in which the citric, figures 
most largely, are of peculiar service. The organic acids generally, besides the large 
proportion of " water of constitution " in them and which is necessary to their existence, 
contain an excess of oxygen over the amount required to form water with the hydrogen, 
and thus liberate a small portion of the oxygenating element to the blood. The liber- 
al use of the tomato ( Solanum Lycopersicum ) is known to produce bilious stools, and 
recently it has been recommended to give it medicinally for that purpose. The organic 
acids combine with alkalies to form salts, and exist in that condition in many fruits and 
culinary vegetables. 

The alkalies play an important part in the chemical quadrille. 

They are found in vegetables and fruits in the condition of alkaline phosphates, — 
phosphate of soda, phosphate of potassa, and phosphate of magnesia ; also as sulphate, 
chloride and phosphate of lime. The importance of these substances after having been 
submitted to the action of the human laboratory is well known. Yet the article which 
is most used as a constant diet in new countries is salted pork, from which these salts 
have all been removed in the process of pickling. The materia alimentaria, as a 
cause of disease or health, has not been sufficiently investigated, and will hereafter yield 
a rich harvest to the earnest laborer, who shall expound a system of laws to meet the 
different conditions of life into which man is thrown as an independent being. 



19 



It has been urged against the view, which we have attempted to put forth in the 
causation of periodic fevers, that sailors on shipboard, do not suffer from them. 

We have already expressed our belief, that chlorine possesses a power, not heretofore 
generally assigned it; that of being a direct or indirect stimulant to the hepatic func- 
tion. Can it be, that enveloped as seamen are, in an atmosphere impregnated with 
salt, (the chloride of sodium) that, that element is supplied to the system in quantities 
sufficient to prevent an accumulation of carbonaceous material? 

We merely suggest the idea, without having given it much thought. Persons suffer- 
ing from protracted intermittents often commence regaining their health upon a remov- 
al to the sea-coast, where they can " smell the salt air. " 

With these remarks, Gentlemen, we close a subject, which to us, has always been one 
of the deepest interest. The great prevalence of the disease in the field which we have 
chosen for our labors, renders it a matter of vital importance to the community that 
we should understand its nature and be ready to detect its myriad shapes, however 
masked they may appear. The treatment has not been touched upon in this paper, 
save so far as to illustrate its aetiology and pathology. That much of what we have 
said, is mere speculation, we are aware ; but we are well convinced that when some fa- 
vored devotee of our science, shall succeed in laying bare the nature of this mysterious 
foe, the road to such a happy consummation, will be found to have its departing point, 
in that but illy understood, and complex organ, the liver. Let it not be understood by 
these remarks that we countenance the rash mercurialization so frequent in the West. 

The intelligent physician will distinguish the conditions we have endeavored to por- 
tray, and apply his remedies judiciously and according to the dictates of a scientific 
medication. 

It has become fashionable among the miasmatists of late years, to brand those who 
recognize its all important function, with the taunt that they can see nothing but the 
liver. Notwithstanding such an ungenerous and narrow-minded insinuation, we have 
dared to announce our unqualified skepticism of the whole miasmatic doctrine, as be- 
ing fallacious upon its face ; dissonant with the accumulated experience of centuries, 
and unworthy of the enlightened age in which it is tolerated. 

There is one property about it, which may well give us pleasure. Miasmata are 
dissipated it is said, by the sun. Let us hope, Gentlemen, that when the glorious sun 
of science, shall have risen in the zenith of his bright effulgence, this ghostly relic of 
a fanciful pathology, shall be banished into thin air, and forever lost in the wondrous 
infinitude of space. 



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